Chapter 6 - Shock And Fluid Therapy

Shock and Fluid Therapy Lesson Six MSTC, FT LEWIS WA

Outline ► IV

Access

► Types

of Fluids

► Shock ► Fluid

Therapy

IV IV Access Access ►18

gauge IV catheter preferred in the field setting because of increased success rate

► Only

started on casualties that need or may need fluid resuscitation

► Large

bore 14 gauge located in CLS bag

 Primarily used for NCD

Initiate a Saline Lock ► Advantages

 Maintains IV access  Eliminates administration of unneeded

fluids  Prevents the need for new venipuncture

each time medication or fluid is to be given

Initiate a Saline Lock ► Equipment

needed

 2-18 Ga catheters  Saline lock adapter plug  Syringe filled with 5 cc sterile saline for flush  Alcohol wipes  Tegaderm dressing

Saline Lock

Saline Lock

Saline Lock

Saline Lock

Saline Lock

Saline Lock

IV IV Access Access ► Select

a site

 Antecubital fossa or back of hand most common area  If possible the non-dominant arm ► Subclavian

or internal jugular venipuncture, and Cutdowns are not appropriate on the battlefield

TYPES OF IV FLUIDS ►

Crystalloid  Normal Saline  Lactated Ringers  Solution that do not contain protein, other large molecules, do not remain in the vascular system very long.

►

Colloid  Hetastarch (Hextend)  Contain protein, sugar or other high molecular weight molecules, used to expand intra-vascular volume. Replaces NS and LR

Normal Saline (NS, 0.9% NaCl) ►Indications

 Solution of choice for blood transfusion ►equals

sodium and chloride in plasma

 To restore body fluids ►90

grams of sodium chloride per 100 ml of water

Ringer’s solution or Lactated Ringer’s (LR) ► Indications

  

Solution of choice for burns Most cases of dehydration Supportive treatment of trauma

► Isotonic

solution that replaces electrolytes

Hextend Hextend ► Retained

in intravascular space

► 500

cc of a colloid such as 6% hetastarch results in an initial intravascular volume expansion of almost 800 cc

Volume expansion sustained for at least 8 hours.

Hextend Hextend vs vs Lactated Lactated Ringer's: Ringer's: Weight Weight Considerations Considerations

►

1500cc blood loss

►

Four hour evacuation

►

Requires infusion of 1000cc of Hextend  Weight: Two Pounds

►

Approximately eight liters of lactated ringer's (about 20 lbs.) to achieve the same effect

►

Colloids reduce the carry weight and volume by up to 75%

►

Question: Where does the extra fluid go?

Shelf Shelf Life Life and and Storage Storage Requirements Requirements ► Important

considerations for resuscitation fluids to be used in military operations

► Similar ► Shelf

for crystalloids and colloids

life is 2 years

► Recommended

to be protected from freezing and from exposures to temperatures above 104 degrees Fahrenheit

Shock ► Assessment

for Shock

 Lack of a radial pulse (indicates BP <80)  Decreased mental status (lack of perfusion to vital organs  Cool, clammy, pale skin  Tachycardia ► Keys

for fluid resuscitation are lack of a radial pulse and/or decreased mental status

Prevent Or Control Shock

Perform First Aid To Prevent Or Control Shock Shock: Failure to provide adequate oxygen to all parts of the body.  There are several causes of shock.  On the battle field hypovolemic (low blood volume) shock will be the primary type of shock present  If not treated, shock can result in death.

Perform First Aid To Prevent Or Control Shock Hypovolemic shock is usually caused by severe bleeding but can also be caused by severe loss of body fluids from:  Severe burns on 20 percent or more of the body surface  Vomiting  Diarrhea  Excessive sweating

Perform First Aid To Prevent Or Control Shock

her indications of hypovolemic shock include:

weaty but cool (clammy) skin, pale skin color, and/or blotchy

r bluish skin around the mouth

Nausea

Anxiety (casualty restless or agitated)

Change in level of consciousness such as mental confusion

ncreased breathing rate

Unusual thirst

Perform First Aid To Prevent Or Control Shock POSITION THE CASUALTY TO PREVENT/CONTROL SHOCK Take measures to prevent or control shock after you:  Restore breathing (if needed)  Control any major bleeding  Dress any major wounds

Perform First Aid To Prevent Or Control Shock

Normal Shock Position

Move the casualty to cover, if possible

Position the casualty on his back

If possible place a poncho or blanket under the casualty

Perform First Aid To Prevent Or Control Shock Elevate the casualty's legs so that his feet are slightly higher than the level of his heart. (This helps the blood in the veins of his legs to return to his heart.)

BAD

BETTER

BEST!

Perform First Aid To Prevent Or Control Shock

ock Positions for Special Injuries tain casualties are not placed in the normal position for shoc

spected Fracture of the Spine:  Do not elevate legs en Chest Wound:  Position them sitting up or lying on injured side en Abdominal Wound:  Keep the casualty on his back with his knees flexed ad Wound:  Suspect spinal injury when severe head is present consciousness:  On side with his head turned

Perform First Aid To Prevent Or Control Shock  Reassure the casualty  Loosen the casualty's clothing  Keep the casualty from being too warm or too cool  Seek help or evacuate casualty (Administer an IV)  Do not give the casualty anything to eat or drink

Fluid Fluid Therapy Therapy ► Large

IV catheters are needed to administer large volumes of blood products rapidly

► Not

a factor in the tactical setting since blood products will not be available

►18

gauge catheter preferred in the field setting

because of increased success rate

Fluid Fluid Therapy Therapy ► Larger

at MTF

gauge IVs may have to be started

► Common

practice to discontinue prehospital IVs upon arrival at MTF because of concern about contamination of the IV site

Fluid Fluid Therapy Therapy 1. Controlled bleeding/ no shock: Saline lock, NO IV fluids required 2. Controlled bleeding/shock: Saline lock, IV Hespan 500 - 1000cc 3. Uncontrolled bleeding: Saline lock, NO IV fluids

Fluid Fluid Resuscitation: Resuscitation: Uncontrolled Uncontrolled Bleeding Bleeding Weight of evidence at this time favors withholding aggressive IV fluid resuscitation in patients with uncontrolled hemorrhage from penetrating thoracic or abdominal trauma until the time of surgical intervention.

Fluid Fluid Therapy: Therapy: Controlled Controlled Bleeding Bleeding Immediate fluid resuscitation is still recommended for casualties on the battlefield whose hypo-volemic shock is the result of bleeding from an extremity wound which has been controlled.

QUIZ! 1) List 4 causes of hypovolemic shock. 2) Indicate how each of the following casualties should be positioned if he has the condition indicated with no additional injuries. a. Open abdominal wound. b. Open chest wound. c. Arm wound with severe blood loss.

Questions????